An Education Gradient in Health, a Health Gradient in Education, or a Confounded Gradient in Both?
Social Science & Medicine 154, April 2016, Pages 18–27. doi:10.1016/j.socscimed.2016.02.029
35 Pages Posted: 24 Mar 2015 Last revised: 11 Mar 2016
Date Written: March 23, 2015
There is a positive gradient relating educational attainment and health, yet the causal direction of the gradient is not clear. Does higher education improve health — an education gradient in health? Or do the healthy become highly educated — a health gradient in education? This study evaluates the direction of the gradient by tracking changes in educational attainment and self-rated health (SRH) from age 15 to age 31 in the National Longitudinal Study of Youth, 1997 cohort (NLSY97). Ordinal logistic regression confirms that there is a health gradient in education: that is, high-SRH adolescents are more likely to become highly educated, partly but not entirely because adolescent SRH is associated with adolescents’ academic performance, college plans, and family background. Fixed-effects longitudinal regression shows that, once initial advantages in SRH are controlled, individuals who complete higher levels of education experience little improvement in their SRH. Completion of a high school diploma or associate’s degree has no effect on SRH at age 31, while completion of a bachelors or graduate degree have effects that, though significant, are quite small (less than 0.1 points on a 5-point scale). While it is possible that educational attainment would have greater effect on health at older ages, at age 31 what we see is primarily a health gradient in education, not an education gradient in health.
Keywords: education gradient in health, health gradient in education, self-rated health, education, fixed-effects
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